An In-Depth Look at Sterilization Monitoring
(Instrument Processing)

By Joyce Moore BSDH, RDH, CRCST

The COVID-19 pandemic has brought a new urgency to infection prevention, serving as a reminder to healthcare professionals that a strong infection prevention program is important to keep patients and caregivers safe. This new urgency has especially highlighted equipment sterilization as a means to reduce transmission of infectious diseases and exposure to contagions.


The dangers surrounding potential transmission of COVID-19 in healthcare settings did not create the need for effective infection prevention measures. Infection prevention has been a focus in healthcare for many years, in both ambulatory and acute care settings.


As discussed in a previous blog post on instrument processing, the Centers for Disease Control and Prevention (CDC) established guidelines in 2008 outlining the five steps in the sterilization process:

  1. Receiving, cleaning and decontamination
  2. Preparation and packaging
  3. Sterilization
  4. Monitoring
  5. Storage

Sterilization begins by following the facility’s standard operating procedures (SOPs) and the equipment and instrument manufacturer’s instructions for use (IFU). The fourth step, monitoring, includes the use of physical, chemical and biological monitors to assure sterilizer efficacy:


  • Physical monitoring includes observing the cycle to be sure that the amount of water in the unit was adequate, and that intended time, temperature and pressure parameters have been met. The use of sterilizer recording devices, in either print or electronic format, can document all relevant conditions. Records should be kept for each cycle; local, state and federal regulations should be followed.

  • Chemical indicators (CI) change color to show that one or more sterilizer parameters were met in each cycle. CI help detect sterilizer malfunction or failure, which can be caused by a number of reasons, including improper loading of the unit.
  • Biological indicators (BI), also known as a spore test, enable validation of sterilizer cycles by assessing the sterilization process directly. BI use viable spores resistant to sterilization – either self-contained or indicator strips. If the spores are killed during the cycle, it is presumed that microorganisms on instruments are also killed. BI should be used at least weekly and each time the cycle load contains an implant. If a sterilizer fails a BI test, it should be removed from service and retested. If repaired, a sterilizer should not be placed back into service until it passes three additional BI tests.


Instrument processing is more than just instrument sterilization. It encompasses the transport, cleaning, disinfection, drying and storage of reusable instruments in a practice, as well as documenting the results of monitoring each sterilization cycle. As you assess your infection prevention efforts, consider standardizing the instrument processing area.  

In this white paper, we discuss the need for effective infection prevention measures and look at three steps that, when taken, can help enhance infection prevention programs and initiatives.